# JEFFREY WILDE MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wilde Desert Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518515683
- **Authorized official:** DR. JEFFREY VIRGIL WILDE MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (520) 255-5475

## Contact information

- **Practice address:** 302 EL CAMINO REAL BLDG 11, SIERRA VISTA, AZ 85635-2860
- **Practice address phone:** (520) 255-5475
- **Practice address fax:** (855) 801-7998
- **Mailing address:** 302 EL CAMINO REAL BLDG 11, SIERRA VISTA, AZ 85635-2860
- **Mailing address phone:** (520) 255-5475
- **Mailing address fax:** (855) 801-7998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2019
- **Last updated:** 03/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 552797 | — | AZ |